02 Musculoskeletal

Which test is the most specific test to diagnose an anterior cruciate ligament (ACL) tear? A) Pivot shift B) Lachman test C) Anterior drawer sign D) Ege's test

A) The pivot shift test is the most specific test to diagnose an ACL tear. Under anesthesia, the specificity approaches 100%. Lachman's test is usually considered the most sensitive test for an ACL tear. Ege's test is used for diagnosis of a meniscal injury.

Rotator cuff tears are characterized by: A) Symptoms similar to rotator cuff tendinitis B) Pain at night with side-lying on the affected side C) Examination findings of supraspinatus weakness, external shoulder rotator weakness, and positive drop arm test D) All of the above

D) A full thickness tear can cause immediate functional impairments. The pain quality can be described as dull and achy, and symptoms are similar to those of rotator cuff tendinitis. The greatest limitation is difficulty performing overhead activities.

What is the most common cause of adhesive capsulitis? A) Diabetes B) Female gender C) Hypothyroidism D) Idiopathic

D) Adhesive capsulitis is usually an idiopathic condition resulting in the loss of both active and passive range of motion (ROM) of the shoulder. It most commonly affects middle-aged adults (40-60 years). Associated risk factors include female gender, diabetes (most common risk factor), and hypothyroidism, among other conditions. None of the aforementioned risk factors have been determined to be primary causes of this condition. Adhesive capsulitis is divided into three stages: freezing stage, frozen stage, and thawing stage.

Which test is useful in determining adequate blood supply to the hand? A) Hoffman's test B) Elson's test C) Phalen's test D) Allen's test

D) Allen's test is used to check for patent ulnar and/or radial artery circulation to the hand. To perform the test, the examiner manually occludes the patient's ulnar and radial arteries while the patient makes a fi st. As the examiner releases pressure one by one, visible reperfusion of the palm indicates patency of the arteries. This test is usually performed prior to doing a radial artery arterial blood gas to ensure that collateral circulation will be possible should the radial artery become occluded.

In patients younger than 20 years who have had a shoulder dislocation, what is the rate of reoccurrence? A) 10% B) 50% C) 75% D) 90%

D) Approximately 90% of patients under 20 years of age will dislocate their shoulder again after a prior dislocation. Individuals age 20 to 40 years old carry a moderate risk of dislocation and there is an approximate 10% rate for dislocation in patients over 40 years.

What causes Boutonnière deformity? A) Ruptured flexor digitorum profundus (FDP) tendon B) Thickening and nodule formation in the flexor tendon sheath C) Median nerve entrapment D) Rupture of the central slip and volar migration of lateral bands

D) Boutonnière deformity is seen in patients with rheumatoid arthritis and is a consequence of disruption of the central slip of the extensor tendons with volar migration of the lateral bands. This results in hyperflexion of the proximal interphalangeal (PIP) joint. Treatment in early stages includes splinting of the PIP joint in extension.

Boxer's fractures involve a fracture of which metacarpal bone? A) First metacarpal B) Second metacarpal C) Third metacarpal D) Fifth metacarpal

D) Boxer's fractures involve a fracture of the fifth metacarpal and are the most common fractures occurring in the metacarpals. They usually occur after the patient strikes a hard object with a closed fi st. Treatment typically involves closed reduction and casting.

Kienböck's disease involves which of the following features? A) Osteonecrosis of the scaphoid B) "Pencil-in-cup" deformities C) Heberden's and Bouchard's nodules D) Osteonecrosis of the lunate

D) Clinical features of Kienböck's disease include pain over the dorsal aspect of the wrist, directly over the lunate. The mechanism is hypothesized to be an idiopathic loss of blood supply to the lunate, causing avascular necrosis. The disease is correlated with repetitive stress or fracture. Risk factors include short ulnar variance and poor vascular supply. In later stages, the collapse of the lunate results in multiple degenerative changes at the wrist.

Ankle eversion injuries often injure the: A) Deltoid ligament B) Anterior talofibular ligament C) Calcaneofibular ligament D) Posterior talofibular ligament

A) Eversion injuries are not as common as inversion injuries but can cause damage to the deltoid ligament. The anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament can be injured in inversion injuries.

What does FABERE (Patrick's test) test for? A) Hip joint dysfunction B) Gluteus medius weakness C) Femoral nerve irritation D) Iliotibial band tightness

A) Flex, abduct, externally rotate the hip, with downward force causing extension is the FABERE test. Anterior hip/groin pain is suggestive of hip joint pathology

Which of the following is false about hip dislocation? A) The most common type is anterior hip dislocation B) Sciatic nerve may be stretched or compressed during posterior hip dislocations C) Femoral nerve may be injured during anterior hip dislocation D) Motor vehicle accidents are the most common cause of hip dislocations

A) The most common type of hip dislocation is posterior (90%).

What is the Adson's test used for? A) To detect thoracic outlet syndrome B) To check for adequate blood perfusion to the hand C) To detect anterior instability of the shoulder joint D) To detect symptoms of carpal tunnel syndrome (CTS)

A) Adson's test is performed by locating the radial pulse of the affected arm and asking the patient to turn their head toward the affected shoulder. The arm may be abducted and externally rotated as part of the maneuver. If the radial pulse diminishes on the affected side, this is positive for possible thoracic outlet syndrome. Thoracic outlet syndrome is the compression of the neurovascular structures in the neck, usually by a cervical rib or first rib and scalene muscles.

The most common cause of collapse in a marathon runner after crossing the finish line is: A) Benign exercise-associated collapse B) Cardiac arrest C) Heat stroke D) Hypoglycemia

A) Benign exercise-associated collapse is due to a form of orthostatic hypotension. When the patient stops running, venous blood pools to the lower extremities and the patient becomes hypotensive, which can cause them to collapse. It can be prevented by having the athlete continue to walk/jog to maintain the muscular venous pumping after the marathon.

Weakness of which muscle would correlate with compression of the C5 nerve root? A) Biceps brachii B) Extensor carpi radialis (ECR) C) Triceps brachii D) Flexor digitorum profundus (FDP)

A) Compression of the C5 nerve root will result in weakness of the biceps brachii. Compression of C6 and C7 nerve roots would result in weakness of the extensor carpi radialis and triceps, respectively. Compression of C8 and T1 nerve roots would result in weakness of fl exor digitorum profundus and abductor digiti minimi (ADM)/interossei, respectively.

Weakness of which muscle would correlate with compression of the T1 nerve root? A) Abductor digiti minimi (ADM)/interossei B) Extensor carpi radialis (ECR) C) Triceps brachii D) Flexor digitorum profundus (FDP)

A) Compression of the T1 nerve root would result in weakness of the ADM/interossei. Compression of C6 and C7 nerve roots would result in weakness of the extensor carpi radialis and triceps, respectively. Compression of the C8 nerve roots would result in weakness of the flexor digitorum profundus

Adhesive capsulitis or frozen shoulder: A) Results from thickening and contraction of the capsule around the glenohumeral joint B) Is more commonly seen in middle-aged men C) Has risk factors including psoriasis D) Is more frequently noted in colder climates

A) Frozen shoulder often follows a period of prolonged shoulder immobilization and results in a decreased range of motion (ROM) of the shoulder. Thickening and contraction of the capsule occurs around the glenohumeral joint. Risk factors include diabetes. It is more commonly seen in middle-aged women.

Which ligament is affected in Gamekeeper's thumb? A) Tear of the ulnar collateral ligament of the thumb metacarpophalangeal (MCP) B) Rupture of the flexor digitorum profundus (FDP) tendon C) Rupture of the extensor tendon from the distal phalanx D) Tear of the triangular fibrocartilage complex

A) Gamekeeper's thumb is an injury to the ulnar collateral ligament of the thumb-MCP joint resulting in joint instability. Usually, the mechanism of injury is a forced radial deviation of the thumb or from a ski pole injury. Patients may describe pain and decreased grip strength at this location. There may be appreciable laxity of the MCP. A palpable mass at the location of the ulnar collateral ligament is called a Stener lesion, where the adductor pollicis aponeurosis falls under the torn collateral ligament.

A finger locked in flexion, especially in the morning, is typical of which condition? A) Trigger finger B) Mallet finger C) Jersey finger D) Boutonnière deformity

A) Individual flexor tendons for each digit of the hand are housed within a flexor tendon sheath. The tendon sheath has areas of thickening called annular and cruciate pulleys that function to stabilize the tendon. In stenosing tenosynovitis (trigger finger), the proximal pulley becomes inflamed and thickened with concurrent nodular enlargement of the tendon itself. As the inflamed tendon passes through the thickened pulley, it occasionally becomes stuck, locking the finger in flexion. This condition usually affects the middle or ring fingers. Therapy includes local steroid injection or surgery.

What is a sign that the stellate ganglion was successfully blocked? A) Ipsilateral Horner's syndrome B) Increased paresthesias C) Anesthesia in the limb D) Increased pain symptoms

A) Ipsilateral Horner's syndrome (dropping eye, pupillary constriction, and increased skin temperature or flushing) indicates that the block was adequate.

Mallet finger is: A) A rupture of the terminal extensor tendon of the distal phalanx B) Identified by a loss of active extension of the proximal interphalangeal (PIP) joint of the finger C) Caused by forced extension of the distal phalangeal joint D) Occurs more commonly in ice hockey than in basketball or baseball players

A) Mallet finger is a rupture of the terminal extensor tendon of the distal phalanx causing loss of active extension of the distal interphalangeal joint. It is usually caused by forced flexion of the distal phalangeal joint as can occur when a ball hits the end of the finger. It occurs most commonly in sports like basketball or baseball.

Rupture of the terminal extensor tendon of the distal phalanx causing loss of active extension is called: A) Mallet finger B) Jersey finger C) Trigger finger D) Coach's finger or jammed finger

A) Mallet finger is usually caused by forced flexion of the distal phalangeal joint. Jersey finger is avulsion of the flexor digitorum profundus from the distal phalanx. It usually occurs in the fourth finger. Trigger finger is thickening of the proximal portion of the flexor tendon sheath which may cause the finger to get "stuck" in flexion. Coach's finger is an interphalangeal dislocation that usually dislocates dorsally.

Throwing athletes, such as baseball pitchers, are most susceptible to which of the following disorders? A) Medial epicondylitis B) Lateral epicondylitis C) Posterior tendon tendonitis D) Bicipital tendonitis

A) Medial epicondylitis is associated with pitchers and golfers. Medial epicondylitis is felt to occur from microtears of the common flexor tendon origin or failed healing response that alters normal biomechanics. Lateral epicondylitis is seen in tennis players

Which statement is not true regarding myositis ossificans of the hip? A) Ultrasound, heat, and massage are conservative treatments for new onset of myositis ossificans B) Prevention of contractures is important C) If possible, surgery should be delayed until the lesion matures at 10 to 12 months D) Myositis ossificans is the formation of heterotopic ossification within muscle

A) Myositis ossificans is the formation of heterotopic ossification within muscle. Prevention of contractures is a priority and can be accomplished by gentle range of motion (ROM). Surgery may be needed if the myositis ossificans causes nerve entrapment, decreased ROM, or loss of function. However, surgery should be delayed until heterotopic ossification matures at 10 to 12 months.

O'Brien's test evaluates for: A) Labral abnormalities B) Bicipital tendinitis C) Stability of the glenohumeral joint D) Thoracic outlet syndrome

A) O'Brien's test evaluates for labral abnormalities. The shoulder is flexed to 90° with the elbow fully extended. The arm is then adducted 15° and the shoulder is internally rotated with the patient's thumb pointing down. Downward force is applied to the arm against resistance. The shoulder is then externally rotated with the palm facing up and the examiner applies downward force on the patient's arm, which the patient is instructed to resist. A positive test is indicated by pain during the first part of the maneuver with the patient's thumb pointing down. The pain is lessened when the patient resists a downward force with the palm facing up

Which portion of the humerus is most commonly affected in osteochondritis dessicans? A) Capitellum B) Medial epicondyle C) Lateral epicondyle D) Greater tubercle

A) Osteochondritis dessicans is characterized by fragmentation of the bone and cartilage overlying the capitellum in the elbow. This condition often occurs in teenage boys involved in throwing sports because of the valgus stress on the elbow. It is often mistakenly confused with Panner's disease, which has more to do with a circulatory problem affecting the bone in the elbow and occurs in children 5 to 12 years of age.

Mechanisms proposed for superior labrum anterior to posterior (SLAP) lesions include: A) Falling on an outstretched arm B) Underhand throwing motion C) Repetitive overhead reaching D) Repetitive resistant elbow extension

A) SLAP lesions occur as a result of falling on an outstretched arm causing a traction and compression injury related to the fall. Overhead throwing motion in the deceleration phase can also cause a SLAP lesion by causing traction on the superior labrum by the biceps muscle. The cocking phase of the overhead throw causes a torsional peeling-back stress to the glenoid labrum leading to a SLAP lesion.

What physical exam finding will be observed in "Saturday night palsy"? A) Marked wrist and finger drop B) Atrophy of abductor pollicis brevis (APB) C) Weak elbow extension D) Painless weakness and atrophy of hand intrinsic muscle

A) Saturday night palsy, honeymooner's palsy, or radial nerve mononeuropathy usually presents with wrist and finger drop. It may present with numbness and paresthesias of the forearm and wrist as well. Acute compression of the radial nerve typically occurs at the spiral groove.

Which of the following is true regarding impact seizures after a mild head injury? A) Do not require treatment B) Occur commonly C) Are associated with structural brain injury D) Always indicates that the patient should stop participating in that sport

A) Seizures can occur within seconds of the insult and do not warrant treatment. They are uncommon and are not associated with structural brain injury or long-term risks. The athlete should not necessarily be eliminated from the sport.

What is the final (last) phase of sports rehabilitation? A) Sports/task-specific activities B) Immobilization C) Restoring range of motion (ROM) D) Strengthening

A) Sports rehabilitation can be categorized into five phases: (1) resolving the pain and inflammation, (2) restoring range of motion, (3) strengthening, (4) proprioceptive training, and (5) sports/ task-specific activities. Immobilization is generally avoided as it can limit range of motion (which can cause contractures and atrophy).

What is the physical exam to test for cervical spine radiculopathy that places the patient in passive lateral flexion and extends the neck, followed by compression of the head? A) Spurling's maneuver B) Lhermitte sign C) Hoffman's sign D) Neck distraction test

A) Spurling's maneuver is a highly specific, but not a sensitive test for cervical radiculopathy. Lhermitte's sign is rapid passive cervical flexion while the patient is seated, which causes a shock sensation. Hoffman's sign signifies an upper motor neuron insult.

The primary function of tendon is to: A) Transmit the force generated by a muscle to bone B) Attach bone to bone C) Be primary joint stabilizers D) Provide nutrition to bone

A) Tendons consist of dense, regularly arranged collagen fibers meshed with elastin and a proteoglycan/glycosaminoglycan ground substance. The primary function of the tendon is to transmit the force generated in muscle to the bone allowing for the generation of movement of the extremities.

Which statement is true regarding the anterior cruciate ligament (ACL)? A) It prevents backward sliding of the femur B) It limits external rotation of the femur when the foot is fixed C) It tightens in flexion and loosens with full extension D) Its deficiency leads to increased pressures on the anterior menisci

A) The ACL originates at the lateral femoral condyle, travels through the intercondylar notch, and attaches to the medial tibial eminence. Its primary function is to limit anterior tibial translation, or prevent backward sliding of the femur. It limits internal rotation of the femur when the foot is fixed. The ACL loosens in flexion and tightens in full extension. ACL pathology leads to increased pressures on the posterior menisci.

What is the function of the fl exor digitorum profundis (FDP) muscles? A) Flexes at the distal interphalangeal (DIP) joint B) Flexes at the proximal interphalangeal (PIP) joint C) Flexes at the metacarpophalangeal (MCP) joint D) Flexes at the wrist

A) The FDP muscle's origin is at the anterior ulna and interosseous membrane. The insertion is the distal phalanx of the index, middle, ring, and small fingers. Its main action is flexion of the DIP joint of the fingers. The FDP is innervated by the anterior interosseous nerve from the median nerve (index and middle fingers) as well as the ulnar nerve (ring and small finger).

Compression of which nerve is commonly misdiagnosed as lateral epicondylitis? A) Posterior interosseous nerve (PIN) B) Anterior interosseous nerve C) Median nerve D) C8/T1 nerve roots

A) The PIN is a deep branch of the radial nerve, which if compressed may present with lateral elbow pain. The PIN usually gets compressed by a fibrous band located between two heads of the supinator muscle (the radial tunnel). Patients may present with symptoms similar to lateral epicondylitis, but remain refractory to treatment. In such situations, an electromyogram (EMG)/nerve conduction study (NCS) should be sought to evaluate for PIN compression.

Which position should be avoided after total hip arthroplasty using an anterior approach? A) Bridging B) Adduction crossing midline C) Sitting on regular toilet seat D) Cross legs

A) The anterior hip dislocation precautions are different from the posterior hip dislocation precautions: no hip extension, bridging, prone lying, or hip external rotation beyond neutral. When the patient is supine, keep the hip flexed to approximately 30° by placing a pillow under the patient's knees or by raising the head of the bed.

Which muscles would most commonly be affected by a nerve injury after an anterior shoulder dislocation? A) Deltoid and teres minor B) Supraspinatus and infraspinatus C) Rhomboids D) Biceps and Supraspinatus

A) The axillary nerve is most commonly injured in an anterior shoulder dislocation. The axillary nerve innervates the deltoid and teres minor. Supraspinatus and infraspinatus are innervated by suprascapular nerve. The suprascapular nerve is rarely associated with glenohumeral dislocation, but can be injured from repetitive traction trauma. The rhomboids are innervated by the dorsal scapular nerve.

Which is the most common site for compartment syndrome? A) Anterior compartment of the lower leg B) Superficial posterior compartment of the lower leg C) Lateral compartment of the lower leg D) Deep posterior compartment of the lower leg

A) The most common site of compartment syndrome is the lower leg. The anterior compartment is the most frequently affected, followed by the lateral compartment and the deep posterior compartment.

Lateral epicondylitis most commonly affects which muscle or muscles? A) Extensor carpi radialis brevis and extensor digitorum communis B) Pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, and flexor digitorum superficialis C) Triceps muscle D) Biceps tendon

A) The pronator teres, fl exor carpi radialis, palmaris longus, fl exor carpi ulnaris, and fl exor digitorum superfi cialis are affected in medial epicondylitis. The triceps muscle is affected in posterior elbow tendonitis. The biceps tendon is affected in bicipital tendonitis.

The proximal tibiofibular joint: A) Is a source of lateral knee pain that is often overlooked B) Is located between the lateral tibial condyle and the fibular head, and has been construed as the "third compartment" of the knee joint C) Is not a synovial joint D) Communicates with the knee joint in approximately 90% of adults

A) The proximal tibiofibular joint is located between the lateral tibial condyle and the fibular head and has been construed as the "fourth compartment" of the knee joint. It is a synovial joint and communicates with the knee joint in approximately 10% of adults. It is a source of lateral knee pain that is often overlooked.

A fall or blow on a hyperextended (dorsiflexed) wrist can cause osteonecrosis of which bone? A) Scaphoid B) Lunate C) Triquetrum D) Pisiform

A) The scaphoid is the most commonly fractured carpal bone (70%). It is subject to osteonecrosis because of its poor blood supply. Clinical features of a scaphoid fracture include tenderness in the anatomical snuff box. Complications include collapse of carpal bones, especially scapholunate instability.

Among the rotator cuff muscles, a tear primarily occurs in which of the following: A) Supraspinatus B) Infraspinatus C) Teres minor D) Subscapularis

A) The supraspinatus is the primary muscle implicated in rotator cuff tears. The supraspinatus tendon has a poor blood supply and is susceptible to chronic subacromial impingement—a mechanism which is rarely seen in people younger than 40 years of age.

What is the most common site for humeral fractures? A) Surgical neck B) Anatomical neck C) Midshaft D) Humeral head

A) The surgical neck is called so because of frequent fractures which occur here. This area lies below the head and tubercle and is narrow. The anatomical neck is located at the junction point of the head with the shaft, and is between the head and tubercles.

Hyperextension injury of the metatarsalphalangeal joint of the great toe is called: A) Turf toe B) Lisfranc injury C) Plantar fasciitis D) Hallux rigidus

A) Turf toe is associated with metatarsophalangeal joint pain that worsens with weight bearing. It can be exacerbated by turf fields which have stiff surfaces.

Which nerve is susceptible to injury with humeral shaft fractures? A) Radial nerve B) Axillary nerve C) Ulnar nerve D) Median nerve

A) Up to 18% of humeral shaft fractures are associated with radial nerve injury, particularly if the fracture occurs at the junction between the middle and distal 1/3 of the shaft. The axillary nerve is the most commonly injured nerve with more proximal humerus fractures (ie, surgical neck fractures).

What is a Bankart lesion? A) Tear or avulsion of the anterior glenoid labrum B) Compression fracture of the posterior humeral head C) Injury to the superior glenoid labrum and biceps tendon (long head) D) Compression of the brachial plexus and/or subclavian vessels as they exit between the superior shoulder girdle and first rib

A) When there is shoulder instability, there are recurrent episodes of subluxation where the humeral head partially comes out of the socket. Anterior instability is more commonly seen than posterior instability, hence dislocations also more commonly occur anteriorly. With recurrent anterior dislocations (where the humeral head remains fully out of socket), the anterior glenoid labrum may become torn or even avulsed off of the glenoid rim (called a Bankart lesion). Choice (B) describes a Hill-Sachs lesion; choice (C) is a SLAP lesion; and choice (D) describes the setting of thoracic outlet syndrome.

Second impact syndrome occurs when a patient: A) Sustains a physical injury at the same time as a concussion B) Sustains a brain injury before the previous concussion symptoms have resolved C) Sustains a second concussion after previous concussion symptoms have resolved D) Sustains a medical condition after a concussion

B) A second trauma can be relatively minor, but the body's response can be fatal. It is believed that the brain's autoregulation becomes impaired from the first injury leading to engorgement within the cranium. This leads to increased intracranial pressures and possible herniation of the medial temporal lobes through the tentorium or herniation of cerebellar tonsils through the foramen magnum.

What does the anterior drawer test assess in the ankle? A) Integrity of calcaneofibular ligament B) Integrity of anterior talofibular ligament C) Integrity of posterior talofibular ligament D) Integrity of deltoid ligament

B) Anterior talofibular ligament. To perform this test, stabilize the distal part of the leg with one hand and apply anterior force to the heel with the other hand. This attempts to sublux the talus anteriorly from beneath the tibia when performing the test.

The glenohumeral joint (shoulder girdle complex) involves articulation of the humeral head with the glenoid fossa and the labrum. Approximately what percentage of the humeral head articulates with the glenoid fossa? A) 15 B) 30 C) 50 D) 70

B) Approximately 30% of the humeral head articulates directly with the glenoid fossa. A fibrocartilaginous complex called the labrum surrounds the glenoid fossa, effectively increasing the total contact of the humeral head with the glenoid to 70%. This allows for the stabilization of the glenohumeral joint and prevents anterior and posterior humeral head dislocation.

What diagnostic test is used to diagnose complex regional pain syndrome (CRPS) in the upper limb? A) Somatosensory evoked potentials (SSEP) B) Stellate ganglion block C) Lumbar vertebral ganglion block D) Erythrocyte sedimentation rate

B) CRPS is a condition characterized as a chronic pain syndrome due to dysfunction in the central and peripheral nervous systems. It presents with changes in skin color and temperature and is accompanied by intense burning pain symptoms and sensitivity. The stellate ganglion block is a sympathetic block used primarily to diagnose and treat symptoms of CRPS. Such blocks are usually performed by a pain specialist and may result in complete or partial pain relief. An adequate block may result in a temporary Horner's syndrome. Sympathetic blocks performed for the lower extremities are called lumbar sympathetic blocks.

What portion of the clavicle is most commonly fractured? A) Distal 1/3 B) Middle 1/3 C) Proximal 1/3 D) Distal 1/3 and proximal 1/3 fractures are equally most common

B) Clavicle fractures are one of the most common bony injuries. The most common location is the middle 1/3 (80%), 15% occur in the distal 1/3, and 5% occur in the proximal 1/3.

Which splint is appropriate for De Quervain's tenosynovitis? A) Nocturnal wrist splint B) Thumb spica splint C) Dynamic extension splint D) Flexor tendon splint

B) De Quervain's tenosynovitis is a condition in which inflammation causes thickening and stenosis of the synovial sheath surrounding the first dorsal compartment of the wrist. This produces pain with tendon movement. On examination, there may be appreciable thickening of the fibrous sheath and Finkelstein's test will be positive. Nonoperative management is indicated in most cases. Splinting with a thumb spica splint is applied such that pinching is possible. Steroid injection can help for symptomatic relief, and surgery may be indicated for decompression in refractory cases.

During which type of contraction is a hamstring injury most likely to occur? A) Concentric muscle contraction B) Eccentric muscle contraction C) Isometric contractions D) Isotonic contractions

B) During concentric contractions, muscles shorten. In eccentric contractions, muscles lengthen. This usually occurs under tension, and the muscles are more prone to injury. Isometric contractions are static where muscle fibers do not change length. Isotonic contractions involve muscle length changes and encompass both concentric and eccentric contraction.

A hip pointer injury is a direct blow to the pelvic brim or hip causing: A) Hip dislocation B) Contusion of soft tissues and underlying bone of the hip C) Hip or femur fracture D) Avascular necrosis of the hip

B) Hip pointers are seen in contact sports such as football and hockey, and are usually seen at the greater trochanter and iliac crest. There can be hematoma formation but there is usually focal tenderness. Patients should have full range of motion of the hip. X-rays should be considered if there is severe pain with passive range of motion.

Evaluation of scoliosis involves the Adam's test (forward bending test) and measuring the Cobb angle using a posterior-anterior (PA) radiograph, which measures: A) The angle formed at the intersection between the horizontal line drawn along the iliac crest and a line drawn along the superior end plate of the vertebra tilted the most at the top of the curve B) The angle formed at the intersection between a line drawn along the superior endplate of the vertebra tilted the most at the top of the curve, and a similar line drawn along the inferior endplate of the vertebra tilted the most at the bottom of the curve C) The angle formed at the intersection between a line drawn along the superior endplate of the vertebra tilted the most at the top of the curve, and a similar line drawn bisecting the center of the curve D) The angle formed at the intersection between a line drawn along the inferior endplate of the vertebra

B) If the Cobb angle exceeds 50° to 60°, abnormalities in pulmonary function tests may appear. Treatments are based on the degree of curvature: 1° to 20°—observation; 20° to 40°—bracing; greater than 40°—evaluation for surgery

Which ligament is most commonly injured in lateral ankle sprains? A) Calcaneofibular ligament B) Anterior talofibular ligament C) Tibionavicular ligament D) Posterior talofibular ligament

B) In lateral ankle sprains, the ligaments within the lateral ligament complex are injured in a predictable sequence as forces increase: anterior talofi bular ligament, calcaneofi bular ligament, then posterior talofibular ligament.

What is the Stimson technique? A) A provocative maneuver to test for glenohumeral instability B) Gravity-assisted technique to reduce an anterior shoulder dislocation C) A two-person technique to reduce an anterior shoulder dislocation, using a sheet under the axilla by one person and manual traction by the other person D) A test for inferior shoulder laxity

B) In the Stimson's technique, the patient with an anterior shoulder dislocation is placed prone on the stretcher with the dislocated arm hanging off the edge of the bed. A 5- to 15-lb. weight is attached to the distal arm so that it is not touching the floor. The physician places their thumb on the patient's acromion and using fingers of the same hand places them over the humeral head. As the patient's muscles gradually relax, the provider gently pushes the humeral head caudally until it reduces. Choice (C) describes another type of technique different from Stimson's.

Gamekeeper's thumb involves an injury to the following structure: A) Medial collateral ligament B) Ulnar collateral ligament C) Transverse carpal ligament D) Triangular fibrocartilage complex

B) Injuries caused by forcible abduction of the thumb are associated with injury to the ulnar collateral ligament of the first metacarpophalangeal joint (MCP). Skiers are at risk owing to falling while holding a ski pole.

What is Kienböck's disease? A) Scaphoid bone fracture B) Avascular necrosis (AVN) of the lunate bone C) Ulnar deviation of the wrist D) Intra-articular fracture affecting the carpometacarpal joint

B) Kienböck's disease is a consequence of traumatic or repetitive microtrauma to the lunate leading to osteonecrosis. Patients present with pain, stiffness, and wrist dysfunction. Physical examination reveals local tenderness over the lunate, limited range of motion (ROM), and decreased grip strength. Radiographs may show lunate sclerosis and degeneration of adjacent joints in later stages. In later stages, wrist fusion may be indicated.

L2 nerve root compression would cause which of the following reflex abnormalities? A) Patellar tendon B) Cremasteric C) Cross adductor D) Achilles tendon

B) L2 nerve root compression would result in cremasteric reflex abnormalities. The cremaster muscle receives innervation via the genitofemoral nerve (L1 and L2). Patellar tendon and Achilles tendon reflexes would be present in L3/L4 and S1 nerve root compressions, respectively. Cross-adductor reflex is a withdrawal reflex on one side, with an inhibitory response on the contralateral side to maintain balance—for example, stepping on a nail would result in flexion of the affected limb and extension of the contralateral limb.

The most sensitive imaging study to detect early changes in avascular necrosis (AVN) of the femoral head is: A) CT B) MRI C) Bone scan D) X-ray

B) MRI of both hips is indicated to assess for a diagnosis of AVN of the femoral head. MRI is most sensitive to early changes with a low signal intensity noted on T1 imaging.

Which of the following constitutes the largest tissue mass in the body (40%-45% of the total body weight)? A) Bone B) Muscle C) Skin D) Blood

B) Muscle comprises 40% to 45% of the total body weight.

Which of the following statements is true regarding the use of continuous passive motion (CPM) following total knee arthroplasty (TKA)? A) The use of CPM has been associated with a decreased incidence of deep vein thrombosis B) The use of CPM has not demonstrated any difference in clinical outcomes at 1 year following surgery C) The use of CPM prevents the incidence of knee flexion contracture D) The use of CPM increases analgesic use in patients who used CPM following TKA

B) No differences have been found in knee range of motion (ROM), pain scores, or analgesic use in patients who used CPM following TKA. One study did reveal some evidence suggesting that CPM can shorten the length of hospital stay and improve knee flexion at early time points, but does not affect other functional outcomes. The postoperative use of a continuous passive motion machine does not improve outcomes after anterior cruciate ligament tear surgical repair either

All of the following are true about iliopsoas bursitis and tendonitis except: A) Condition may cause snapping hip syndrome with flexion B) Pain is elicited with hip extension C) Pain is usually noted deep in the groin and radiates to the front of hip D) Refers to a stretch, tear, or complete rupture of the iliopsoas muscle and tendon where the tendon attaches to the femur

B) Pain is elicited with hip flexion. The acute injury often involves eccentric contraction of the iliopsoas muscle or rapid flexion against extension force/resistance, but may less commonly result from direct trauma. The overuse phenomenon may occur in any activity resulting in repeated hip flexion or external rotation of the femur.

What is the most common cause of nontraumatic elbow joint destruction? A) Osteoarthritis B) Rheumatoid arthritis C) Repetitive valgus stress injury D) Gout

B) Rheumatoid arthritis is the most common cause of elbow joint destruction and occurs in most patients who have polyarticular involvement.

What is the usual mechanism of a scaphoid fracture? A) Axial compression and hyperextension of the wrist B) Fall onto outstretched hands C) Direct blow to the scaphoid bone D) End-on blow of the fist, as in boxing

B) Scaphoid fractures are the most common carpal bone fractures. The usual mechanism of injury (as is the case with most carpal fractures) is a fall on outstretched hands. Patients will have tenderness in the anatomical "snuffbox" area and decreased range of motion (ROM). Fracture of the middle 1/3 of the scaphoid bone (known as the waist) is most common. This bone has retrograde blood supply, making it particularly susceptible to malunion or avascular necrosis following a fracture. It is for this reason that a low threshold of suspicion is maintained for scaphoid fractures, and immobilization is usually initially prescribed if there is high clinical suspicion (despite negative x-rays).

Which of the following is a static stabilizer of the shoulder joint? A) Biceps tendon B) Labrum C) Supraspinatus muscle D) Subscapularis muscle

B) Static and dynamic stabilizers contribute to shoulder joint stability. Static stabilizers are glenoid, labrum, articular congruity, glenohumeral ligaments and capsule, and negative intraarticular pressure. The dynamic stabilizers are rotator cuff muscles/tendons, biceps tendon, and periscapular muscles.

Scoliosis can be classified as structural or functional. Which one of the following is not characteristic of structural scoliosis? A) Most cases are idiopathic B) It is reversible C) Subtypes of structural scoliosis include idiopathic D) Subtypes of structural scoliosis include congenital or acquired

B) Structural scoliosis is not reversible. Subtypes include idiopathic, congenital, or acquired. Idiopathic scoliosis accounts for 80% of structural scoliosis.

Which is not a characteristic of plantar fasciitis? A) Affects females more than males B) Tenderness over lateral aspect of the heel C) Pain is worse in the morning D) Heel spurs may contribute to the etiology

B) Tenderness usually occurs over the medial aspect of the heel in plantar fasciitis

O'Donoghue's triad (the unhappy triad) consists of tears of which of the following? A) Anterior cruciate ligament (ACL), medial collateral ligament (MCL), and lateral meniscus B) ACL, MCL, and medial meniscus C) ACL, MCL, and lateral collateral ligament (LCL) D) ACL, MCL, and posterior collateral ligament (PCL)

B) The ACL, MCL, and medial meniscus are structures that are damaged in the unhappy triad. This usually occurs in contact sports, usually with valgus stress and rotation of the knee. Lateral meniscus tears can also be seen with ACL and MCL injuries.

The cruciate ligaments are important knee structures which lie: A) Inside the joint capsule, and within the synovial cavity as well B) Outside the synovial cavity but within the fibrous joint capsule C) Outside the fibrous joint capsule D) Outside the synovial cavity and fibrous joint capsule

B) The cruciate ligaments lie outside the synovial cavity but within the fibrous joint capsule.

The articulations of the elbow joint: A) Allow 3 degrees of freedom B) Allow 2 degrees of freedom C) Allow normal range of motion (ROM) of −10° extension to 120° flexion D) Allow 30° to 40° of pronation

B) The elbow articulations allow the elbow two degrees of freedom: flexion-extension and pronation-supination. The normal elbow moves from 0° (full extension) to 135° to 150° of flexion. Pronation is approximately 70° to 90°, and supination is approximately 80° to 90°.

In a posterior hip dislocation, how will the leg be positioned? A) Extended, adducted, internally rotated B) Flexed, adducted, internally rotated C) Extended, abducted, externally rotated D) Flexed, adducted, externally rotated

B) The hip will be flexed, adducted, and internally rotated. The affected leg is shorter because the dislocated femoral head is higher than on the normal side, and the patient will be unable to abduct the affected side.

What is the most common pathological "mass" to occur in the wrist joint? A) Madelung's deformity B) Ganglion cyst C) Heterotopic ossification D) Giant cell tumor of tendon sheath

B) The most common "mass" to occur in the wrist is a ganglion cyst. It is essentially a "ballooning-out" of the joint lining and the fluid inside is synovial fluid. Ganglion cysts most commonly occur on the dorsal aspect of the wrist (usually from the scapholunate joint). On physical examination, the cyst may transilluminate. They can be evaluated by MRI, while x-rays will often be normal. Observational management is indicated for asymptomatic cases. If the cysts interfere with activity, aspiration may be warranted. Ganglion cysts tend to recur at a rate of 20%, while recurrence rate drops to less than 10% following excision.

What is not true about hip fractures? A) Females are more likely than males to sustain a hip fracture B) Most common underlying cause is weakened bone from metastatic disease C) Approximately 25% of patients over age 50 years with hip fractures die within 1 year D) About 50% of hip fracture patients require some form of assistive device

B) The most common cause of hip fractures is osteoporosis. In the vast majority of cases, a hip fracture is a fragility fracture owing to a fall or minor trauma in someone with weakened, osteoporotic bone. They are classified as intracapsular, which includes femoral head and neck fractures, or extracapsular, which includes trochanteric, intertrochanteric, and subtrochanteric fractures. The location of the fracture and the amount of angulation and comminution play integral roles in the overall morbidity of the patient, as does the preexisting physical condition of the individual. The other options are all true.

Which activity will most likely aggravate patellofemoral pain syndrome? A) Ambulation B) Climbing stairs C) Stationary cycling D) Swimming

B) The patellofemoral joint is under high levels of compression during stair climbing owing to significantly increased quadriceps activity.

Injury to the long thoracic nerve affects the function of serratus anterior, which functions primarily to: A) Stabilize the scapula by drawing it inferiorly and anteriorly against the thoracic wall B) Protract the scapula and hold it against the thoracic wall C) Elevate the scapula and tilt the glenoid cavity by rotating the scapula D) Medially rotate and adduct the arm; helps hold the humeral head in the glenoid cavity

B) The serratus anterior protracts the scapula and holds it against the thoracic wall. The other choices refer to the pectoralis minor (A), levator scapulae (C), and subscapularis (D).

Hypertrophic cardiomyopathy is an autosomal dominant hereditary condition in which the patient has a defect in: A) Dystrophin protein B) Sarcomere contractile proteins C) Mitochondria D) Tau protein

B) This defect leads to increased ventricular muscle mass but not an increase in ventricular cavity size. Hypertrophic cardiomyopathy leads to a net reduction in inner ventricular cavity size because of the hypertrophied muscle. Dystrophin abnormalities are seen in Duchenne muscular dystrophy. Tau proteins are affected in Alzheimer's disease.

Thomas' test is used to assess: A) Lumbar lordosis B) Hip flexion contracture C) Sacroiliac joint dysfunction D) Iliotibial band contracture

B) Thomas' test is used to assess for a hip flexion contracture. With the patient supine, fl ex one hip to obliterate the lumbar lordosis. The angle between the affected thigh and the table reveals the fixed flexion contracture of the hip. Ober's test is used to assess for an iliotibial band contracture.

Writer's cramp: A) Is the least common type of dystonia B) Is a task-specific focal dystonia C) Improves after attempts to perform a specific task, such as writing D) Has a poor prognosis

B) Writer's cramp is the most common type of dystonia. Patients with dystonia have simultaneous contraction of agonist and antagonist muscle groups. Initial complaints present as poor coordination, cramping, and aching of the hand with task-specific movements. Prognosis for recovery is good.

The diagnosis of aseptic noninflammatory olecranon bursitis: A) Is based on plain radiographs, demonstrating an olecranon spur in all cases B) Requires aspiration of bursal fluid in all cases C) Is usually straightforward and based on characteristic appearance on physical examination D) Is made only with MRI

C) Additional studies are not usually necessary. If crystal-induced or septic bursitis is suspected, aspiration of the bursal fluid is usually indicated. Plain radiographs may demonstrate an olecranon spur in about 1/3 of cases.

Intrinsic factors contributing to the development of tendinitis include all of the following except: A) Age B) Genetic predisposition C) Poor training technique D) Muscle imbalance/weakness

C) Age, muscle imbalance (weakness), anatomic malalignment, and genetic predisposition are all intrinsic factors that contribute to the development of tendinitis. Extrinsic variables include training errors, environmental factors, and equipment.

What is the pathophysiology behind avascular necrosis of the femoral head? A) Sepsis B) Crystalline deposits C) Interruption of the vascular supply D) Friction

C) Also known as osteonecrosis of the hip or aseptic necrosis of the hip, this condition is characterized by destruction of the femoral head without sepsis. Interruption of the vascular supply is the defining common pathway of the disease process. The most common causes in adults are steroid use or alcohol abuse.

An anterior superior iliac spine (ASIS) avulsion fracture can be caused by forceful contraction of: A) Long head of the biceps femoris B) Vastus intermedius muscle C) Sartorius muscle D) Iliopsoas muscle

C) An avulsion fracture of the ASIS, especially in an adolescent athlete, often occurs from forceful eccentric contraction of the sartorius or tensor fascia lata muscle with hip extension and knee flexion, as in sprinting or swinging a baseball bat. Surgery may be needed for a displaced apophysis. The rectus femoris muscle is involved in an anterior inferior iliac spine avulsion fracture.

What is the most common type of hip fracture? A) Femoral neck B) Intracapsular C) Intertrochanteric D) Subtrochanteric

C) An intertrochanteric hip fracture occurs three to four inches from the hip joint. This type of fracture does not interrupt the blood supply to the bone and may be easier to repair.

Which condition/injury is not considered an absolute contraindication for return to play? A) Atlantoaxial instability noted on lateral fl exion-extension x-rays B) Fused C1 to C2 segments C) A two- to three-level spinal fusion with normal exam D) An acute spinal fracture

C) Answers A, B, and D are all absolute contraindications to return to play. A two- to three-level spinal fusion with normal exam is considered a relative contraindication. A one-level fusion with normal alignment and physical exam has no restriction whereas a fusion extending more than three levels is an absolute contraindication for return to play.

Hill-Sachs lesion of the shoulder: A) May be associated with posterior dislocations B) May cause shoulder instability if it accounts for 10% of the articular surface C) Is a compression fracture of the posterolateral aspect of humeral head caused by abutment against the anterior rim of the glenoid fossa D) Is evaluated by Speed's test

C) Anterior glenohumeral stability is evaluated by the apprehension test. Hill-Sachs lesion accounting for greater than 30% of the articular surface may cause shoulder instability. A notch occurs in the posterior lateral aspect of humeral head owing to recurrent impingement.

Cervical disc disease most commonly affects which disc? A) C3-C4 B) C4-C5 C) C5-C6 D) C6-C7

C) C5-C6 is the most common cervical disc disease followed by C6-C7 and then C4-C5.

Medial winging of the scapula is caused by which of the following nerve injuries? A) Weakness of serratus anterior due to spinal accessory nerve injury B) Trapezius weakness due to long thoracic nerve injury C) Serratus anterior weakness due to long thoracic nerve injury D) Trapezius weakness due to spinal accessory nerve injury

C) Choices (A) and (B) are paired with the incorrect nerves. Choice (D) is responsible for lateral winging of the scapula.

De Quervain's stenosing tenosynovitis is inflammation of the first dorsal compartment, which includes which of the following? A) Abductor pollicis longus and opponens pollicis B) Extensor pollicis brevis and opponens pollicis C) Abductor pollicis longus and extensor pollicis brevis D) Adductor pollicis longus and opponens pollicis

C) De Quervain's affects the abductor pollicis longus and extensor pollicis brevis tendons. It can be seen with overuse in sports with gripped equipment such as golf and racquet sports. The patient usually has pain with resisted thumb extension. Finkelstein's test can be positive.

Which finger is commonly affected in Dupuytren's contracture? A) The index finger B) The middle finger C) The ring finger D) The pinky finger

C) Dupuytren's contracture most commonly involves the ring fi nger. This condition appears in the fourth to sixth decade of life and is more severe in males of northern European descent. The pathophysiology results in collagen type III hyperproliferation affecting the palmar fascia. Treatment includes serial triamcinolone injections in early stages, collagenase injections, and surgery.

What radiographic fi nding is typical of osteoarthritis? A) Periarticular osteopenia B) "Pencil-in-cup" deformity C) Subchondral cysts D) Soft tissue swelling

C) Typical radiographic features of osteoarthritis include joint space narrowing, osteophyte formation, and subchondral cysts. Periarticular osteopenia/osteoporosis and soft tissue swelling are typically seen in rheumatoid arthritis. Pencil-in-cup deformity is a finding in psoriatic arthritis.

The popliteus muscle performs an important action of unlocking by: A) Internally rotating the femur on the tibia during an open chain movement B) Externally rotating the tibia on the femur during an open chain movement C) Externally rotating the femur on the tibia during a closed chain movement D) Internally rotating the tibia on the femur during a closed chain movement

C) During the last 20° of extension of the knee, the femur slightly internally rotates on the tibia to lock the knee joint in place in the closed chain, or the tibia slightly externally rotates on femur in the open chain, which is also called the screw-home mechanism. In the closed chain, the popliteus can externally rotate the femur to unlock the knee for flexion.

Female athletes have been shown to: A) Have a smaller surface area-to-mass ratio, higher bone mass, and a narrower pelvis as compared to males B) Have less menstrual irregularities compared to nonathletic females C) Have skeletal demineralization which can lead to premature osteoporosis D) Have less disordered eating when compared to male athletes

C) Female athletes were seen to have more skeletal demineralization, inadequate eating, and menstrual abnormalities. On average, women have a larger surface area-to-mass ratio, lower bone mass, and a wider, shallower pelvis than men.

A positive Froment's sign hints to which nerve being injured? A) Median nerve B) Radial nerve C) Ulnar nerve D) Musculocutaneous nerve

C) Froment's sign is performed by asking the patient to pinch a piece of paper between his or her index finger and thumb while the examiner tries to pull the paper away. If the patient fl exes the first interphalangeal joint, suggesting adductor pollicis weakness, the test is considered a positive Froment's sign and indicates possible ulnar nerve palsy.

In heat exhaustion: A) The patient needs to be hyperthermic to be diagnosed B) There are known chronic and long-lasting effects C) The cardiovascular system fails to respond to increased workload due to heat D) It is considered a medical emergency

C) Heat exhaustion is due to failure of the cardiovascular system to respond to an increased workload secondary to heat. Heat stroke is considered a medical emergency (when the rectal core temperature is greater than 39°C). Heat stroke can cause organ damage. Heat stroke can occur because of endogenous heat production, and does not necessarily occur only in warm environments. The treatment is immediate cooling

Heberden's nodes are found in which condition? A) Rheumatoid arthritis B) Psoriatic arthritis C) Osteoarthritis D) Gout

C) Heberden's nodes are swellings of the distal interphalangeal joints seen in osteoarthritis. Contents of these swellings are gelatinous hyaluronic acid. These growths arise in the chronic phase of osteoarthritis.

Shoulder impingement may result from: A) C6 radiculopathy B) Loss of competency of the biceps tendon C) Loss of competency of scapula-stabilizing muscles D) Thoracic outlet syndrome

C) Impingement can result from extrinsic compression or as a result of loss of competency of the rotator cuff and/or scapula-stabilizing muscles. The biceps tendon also passes within the space. The impingement interval, which is the space between the undersurface of the acromion and the superior aspect of the humeral head, is maximally narrowed when the arm is abducted.

Scapula winging is caused by an injury to which one of the following nerves? A) Radial nerve B) Suprascapular nerve C) Long thoracic nerve D) Axillary nerve

C) Injury to the long thoracic and spinal accessory nerves causes weakness of the serratus anterior and trapezius muscles, respectively, and are most commonly associated with scapular winging. Patients present with symptoms of pain in the upper back or shoulder, muscle fatigue, and weakness with the use of the shoulder. Initial management includes immobilization to prevent overstretching of the weakened muscle.

Which of the evaluations below is the most important part of the physical evaluation of an athlete? A) Nephrology evaluation B) Pulmonary evaluation C) Cardiovascular evaluation D) Neurologic evaluation

C) It is important to identify and prevent sudden cardiac death during physical activity. Conditions such as hypertrophic cardiomyopathy, arrhythmias, coronary artery anomalies, ruptured aortic aneurysms, and commotio cordis are some examples of dangerous and life-threatening conditions.

Most patients with a grade II ankle sprain will present with: A) Pain in the ankle with no ligamentous injury B) Mild sprain of the anterior talofibular ligament and negative ankle drawer test C) Disruption of the anterior talofibular ligament, sprain of the calcaneofibular ligament, and positive ankle drawer test D) Disruption of the anterior talofibular ligament, the calcaneofibular ligament, and the lateral ligament complex, with a positive ankle drawer test

C) It is important to rule out a fracture of the fibula and/or the fifth metatarsal. Mild sprain of the anterior talofibular ligament and negative ankle drawer test is considered a grade I ankle sprain. Disruption of the anterior talofibular ligament, the calcaneofibular ligament, and the lateral ligament complex with positive ankle drawer test is considered a grade III ankle sprain.

Which test helps determine if a patient has an anterior cruciate ligament (ACL) injury? A) McMurray's test B) Apley's grind test C) Lachman's test D) Quadriceps active test

C) Lachman's test is the most sensitive test for ACL injury or laxity. McMurray's and Apley's grind tests assess injury to the lateral meniscus and medial meniscus. The quadriceps active test assesses posterior collateral ligament disruption.

What diagnostic test is the "gold standard" for evaluation of the rotator cuff? A) Plain x-ray B) Physical exam of the shoulder C) MRI D) Ultrasound

C) MRI has replaced arthrography as the gold standard test for rotator cuff injuries. It offers high sensitivity and specificity that can be used to identify size, location, and quality of injury. It is relatively expensive and requires lack of motion by the patient in order to avoid artifact.

Most common site of Morton's neuroma is: A) The first intermetatarsal space B) The second intermetatarsal space C) The third intermetatarsal space D) The fourth intermetatarsal space

C) Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve, and most commonly affects the third intermetatarsal space (between the third and fourth metatarsal bones).

Test(s) to evaluate for shoulder impingement syndrome include: A) Finkelstein's test B) Speed's test C) Neer's sign D) Tinel's test

C) Neer's impingement sign is performed by bringing the arm in extreme forward flexion with the humerus externally rotated. Hawkins' test is also used to assess for impingement sign. The arm is forward flexed to 90° and medially rotated. A positive sign elicits pain during movement. Speed's test is used to assess for bicipital tendonitis. Finkelstein's test is used to assess for De Quervain's, and Tinel's test is used to evaluate for nerve irritability

What is the test to check for contraction of the iliotibial band? A) Thomson's test B) Painful arc test C) Ober's test D) Yergason's test

C) Ober's test is used to assess for tensor fascia lata/iliotibial band tightness. Thomson's test is used to assess for Achilles tendon injury or rupture.

A 35-year-old male plumber presents with right elbow pain. You diagnose right lateral epicondylitis. What would be expected on physical exam? A) Pain with passive wrist extension B) Pain with resisted wrist fl exion and pronation C) Pain with resisted wrist extension and supination D) Pain with resisted wrist extension and pronation

C) Pain with resisted wrist extension and supination as well as pain with passive wrist flexion are seen in lateral epicondylitis. Once diagnosed, it is important to identify the behavior causing the problem, and to modify it. Pain with wrist flexion and pronation, as well as pain with passive wrist extension, is seen in medial epicondylitis

When is it safe for a patient to return to play after a concussion is diagnosed? A) Patient can return to the game once they are asymptomatic B) Neuroimaging must confirm that there is no structural damage C) Patient must follow a stepwise approach and will be cleared once asymptomatic in all steps D) Patient is able to play as long as there was no loss of consciousness

C) Patients must be asymptomatic before starting the stepwise approach, which goes from light aerobic activity to sport-specific training to non-contact drills to full contact practice to game play. The patient is able to progress as long as they are asymptomatic in all steps.

Which radiographic view is used to visualize the humeral head for possible Hill-Sachs lesion? A) Scapular Y view B) West point view C) Stryker notch view D) Lateral view

C) Recurrent anterior shoulder dislocations can lead to a compression fracture of the posterolateral humeral head known as a Hill-Sachs deformity. Radiographic evaluation with anterior-posterior views and Stryker notch view are used. In the Stryker notch view, the patient is supine with a cassette placed under the involved shoulder. The palm of the affected arm is placed on top of the head with the fingers pointing posteriorly, and the elbow pointing upward toward the ceiling. The x-ray beam is centered over the coracoid process with the beam directed 10° towards the head.

Scoliosis can be classified as structural or functional. Which one of the following is not characteristic of functional scoliosis? A) Can be due to muscle spasm B) Can be secondary to a herniated disc C) Can be due to senile changes in person's spine D) Can be postural

C) Senile changes in a person's spine result in the acquired type of structural scoliosis, which is not reversible. All other answer choices are characteristic of functional scoliosis and are reversible

Shoulder flexion involves the use of all of the following muscles except: A) Anterior deltoid B) Biceps brachii C) Coracobrachialis D) Teres major

C) Shoulder flexion involves the use of the anterior deltoid, pectoralis major, biceps brachii, and coracobrachialis.

What is a Smith's fracture? A) Fracture of the distal radius with dorsal displacement B) Fracture of the distal ulna with dorsal displacement C) Fracture of the distal radius with volar displacement D) Fracture of the distal ulna with volar displacement

C) Smith's fracture is when the distal radius becomes fractured and the distal fragment is displaced toward the palm (volar). It is also called a reverse Colle's fracture because in a Colle's fracture the distal radial fragment is displaced dorsally

What physical exam maneuver is used to detect biceps tendonitis? A) Hawkins' test B) Neer's test C) Speed's test D) Empty can test

C) Speed's test is performed by asking the patient to anteriorly fl ex the shoulder against resistance while the elbow is extended. Hawkins' and Neer's both test for rotator cuff impingement. Empty can test is used to detect supraspinatus tendinopathy.

An Achilles tendon injury is most likely to occur with what action? A) Sudden pivoting B) Internal rotation of the ankle C) Abruptly starting a sprint D) Walking uphill

C) The Achilles tendon attaches the gastrocnemius to the heel. As the muscle shortens, the tendon plantarflexes the foot. An acute injury occurs when a healthy tendon is subjected to a sudden, unexpected force, such as pushing off for a sprint or landing from a jump.

What is a Rockwood type II acromioclavicular (AC) joint injury? A) Sprain of the AC and coracoacromial (CC) ligaments B) Torn CC ligament and intact AC ligament C) Torn AC ligament and sprained CC ligament D) Torn AC and CC ligaments

C) The Rockwood classifi cation system is used to describe AC joint injuries. Type I is mild injury with intact AC and CC ligaments. Type II is a complete tear of the AC ligament and intact CC ligament. Type III to VI each describe complete disruption of both AC and CC ligaments with varying degrees of dislocation of the clavicle. In type III injuries, the clavicle is displaced superiorly, whereas in type IV the clavicle is displaced superiorly and posteriorly into the trapezius. In type V injuries, the clavicle is displaced superiorly with more than 100% increase in the coracoclavicular interspace. In type VI, the clavicle is displaced inferiorly below the acromion or coracoid process.

What are the signs of a positive Trendelenburg's test? A) When the pelvis on the unsupported side stays the same height B) When the pelvis on the unsupported side is elevated slightly C) When the pelvis on the unsupported side descends D) When the pelvis on the supported side stays level

C) The Trendelenburg's sign indicates gluteus medius weakness. The strength of the gluteus medius (which acts as an abductor) is assessed. If the unsupported side descends, this is a positive test. For example, pelvic drop on the right side in a patient standing on left leg indicates left gluteus medius weakness.

Rehabilitation in patients with patellofemoral syndrome is focused on strengthening of which muscle? A) Vastus lateralis B) Rectus femoris C) Vastus medialis obliquus (VMO) D) Vastus intermedius

C) The VMO is a dynamic medial stabilizer which helps maintain proper patellar tracking during extension of the knee.

Which joint is most commonly dislocated among pediatric patients? A) Shoulder B) Hip C) Elbow D) Proximal interphalangeal (PIP) joint

C) The most commonly dislocated joint in children is the elbow. The elbow is the second most commonly dislocated joint in adults.

Which muscle is the most powerful forearm supinator? A) Supinator muscle B) Pronator teres muscle C) Biceps brachii muscle D) Brachioradialis muscle

C) The most powerful forearm supinator is the biceps brachii. This muscle has two proximal attachments. The short head attaches to the coracoid process, whereas the long head attaches to the supraglenoid tubercle of the scapula. The distal attachment is at the radial tuberosity and bicipital aponeurosis into fascia of the forearm. The biceps brachii is innervated by the musculocutaneous nerve, and this muscle is best tested when the forearm is placed in fl exion and supination.

All of the following are true about piriformis syndrome except: A) The sciatic nerve may be involved because in some individuals the nerve runs through the piriformis muscle fibers B) Pain may be in lateral buttock, posterior hip and thigh, sciatica-like pain C) Pain with flexion, abduction, and external rotation D) Pain may be exacerbated by walking up stairs or prolonged sitting

C) The provocative test for piriformis syndrome is flexion, adduction, and internal rotation (FAIR), which helps reproduce the symptoms.

The rotator cuff muscles include all of the following except: A) Teres minor B) Supraspinatus C) Rhomboids D) Infraspinatus

C) The rotator cuff muscles include the teres minor, supraspinatus, infraspinatus, and subscapularis muscles. These muscles are dynamic stabilizers of the shoulder.

Where is the lesion if a patient presents with isolated infraspinatus weakness and atrophy? A) The suprascapular notch B) The C5 nerve root C) The spinoglenoid notch of the scapula D) The upper trunk of the brachial plexus

C) The suprascapular nerve is commonly compressed at the level of the suprascapular notch, resulting in deep, boring shoulder pain along the superior scapula and weakness of shoulder abduction and external rotation. If nerve entrapment occurs at the level of the spinoglenoid notch, then the only appreciable finding may be isolated atrophy and weakness of the infraspinatus muscle. Pain is not so prominent at this level because the sensory fibers have already exited.

The true leg length should be measured between: A) Greater trochanter and lateral malleolus B) Umbilicus and lateral malleolus C) Anterior superior iliac spine (ASIS) and medial malleolus D) Anterior inferior iliac spine and medial malleolus

C) The true leg length should be measured from anterior superior iliac spine to medial malleolus. Apparent leg length discrepancy should be assessed if no true leg length discrepancy exists by measuring from a nonfixed point (eg, umbilicus) to a fixed point (eg, medial malleolus), which may be associated with pelvic obliquity

A 22-year-old football player presents with right knee pain. His history reveals that he received a posteriorly directed force to his bent knee. Physical examination reveals a positive posterior drawer sign. What injury has the patient most likely sustained? A) Patello-femoral syndrome B) Anterior cruciate ligament (ACL) injury C) Posterior cruciate ligament (PCL) injury D) Medial collateral ligament (MCL) injury

C) This injury can occur when there is a force to a flexed knee. PCL injuries can also be seen in motor vehicle collisions. Isolated PCL injury rehabilitation is focused on quadriceps strengthening and closed kinetic training.

How do you measure for leg length discrepancy? A) Anterior superior iliac spine (ASIS) to lateral malleolus B) Posterior superior iliac spine (PSIS) to lateral malleolus C) ASIS to medial malleolus D) PSIS to medial malleolus

C) To assess for a leg length discrepancy, measure from the anterior superior iliac spine to the medial malleolus. Leg length discrepancies of less than 1/2 in. do not need correction.

Myofascial pain syndrome is characterized by: A) Widespread tenderness B) Tender points C) Trigger points D) No change in muscle tension

C) Trigger points can develop owing to a variety of factors, including direct or indirect trauma, overuse, or stress. A trigger point is an area of tautness, which on compression can cause local or referred manifestations. Trigger points can refer symptoms to more remote regions. In contrast, palpation of a tender point causes local discomfort without referred pain.

A newborn is holding his head with his chin rotated toward the left and the ear approximating the right shoulder. Which muscle is primarily implicated? A) Left cervical paraspinal B) Right cervical paraspinal C) Left sternocleidomastoid D) Right sternocleidomastoid

D) Congenital torticollis occurs in approximately 1 per 250 live births, with 75% involving the right side. The most common cause is fibrosis of the sternocleidomastoid. The presence of a cervical hemivertebra is less common. On physical examination, a nontender enlargement in the sternocleidomastoid is noted

What provocative maneuver is used to test for lateral epicondylitis? A) Empty can test B) Valgus stress test C) Elbow flexion test D) Cozen's test

D) Cozen's test is performed with the examiner stabilizing the patient's elbow and his or her thumb over the extensor tendon origin along the lateral epicondyle. With the opposite hand, the examiner provides resistance as the patient tries to extend and radially deviate the wrist. Pain over the lateral epicondyle indicates a positive test.

De Quervain's is a tenosynovitis involving which two tendons? A) Extensor pollicis longus (EPL) and flexor digitorum superficialis (FDS) B) Abductor pollicis brevis (APB) and flexor digitorum profundus (FDP) C) Flexor carpi radialis (FCR) and palmaris longus (PL) D) Extensor pollicis brevis (EPB) and abductor pollicis longus (APL)

D) De Quervain's is a tenosynovitis of the first dorsal compartment of the hand/wrist. The APL and EPB tendons are involved. Finkelstein's test is usually positive (pain is elicited along the radial aspect of the wrist when the wrist is forced into ulnar deviation with the thumb in a closed fist).

Which provocative test is useful in detecting rotator cuff impingement? A) Drop arm test B) O'Brien test C) Apley scarf test D) Neer's test

D) Four muscles (infraspinatus, supraspinatus, subscapularis, and teres minor) form the rotator cuff. The insertion point of these four muscles is subject to repetitive microtrauma and impingement between the acromion and greater tuberosity of the humerus. Impingement syndrome, supraspinatus syndrome, and bursitis are terms commonly used. Neer's test will be positive in the setting of impingement. Hawkins' test can also be performed to further confi rm impingement. Drop arm test is used to detect rotator cuff tears. O'Brien test can be used to detect superior labrum anterior to posterior (SLAP) lesions or acromioclavicular (AC) joint abnormalities. Apley scarf test is also used to detect AC joint pathology.

All the following are benefi ts of ice in the treatment of acute tendinitis except: A) Local vasoconstriction B) Decreased metabolic rate C) Decreased swelling D) Local vasodilatation

D) Ice is used more frequently in the acute stages of inflammation, particularly during the fi rst 24 to 48 hours. It is a very effective anti-inflammatory modality. Benefits of ice include vasoconstriction, decreased swelling, and relief of pain and muscle spasm.

If a patient is supine with knees flexed to 90° and feet flat on the table, how will it be determined if the right femur is longer than the left? A) Left knee is higher than the right B) Right knee is higher than the left C) Left knee is anterior to the right D) Right knee is anterior to the left

D) If one knee projects further anteriorly in the position described, then that femur is longer. In this case, the right knee will be anterior to the left. If one knee is higher than the other, that tibia is longer.

In Erb's palsy, what part of the brachial plexus is affected? A) The lower trunk (C8-T1) B) Both upper and lower trunks C) Middle trunk (C7) D) The upper trunk (C5-C6)

D) In Erb's palsy, the upper trunk of the brachial plexus is affected (C5-C6) resulting in shoulder abduction, elbow flexion, and forearm supination weakness. It is the most common brachial plexopathy seen in newborns.

Internal snapping hip syndrome is caused by: A) A tight iliopsoas tendon snapping over the lesser trochanter B) A tight iliotibial band snapping over the greater trochanter C) A tight gluteus maximus snapping over the greater trochanter D) An acetabular labral tear or loose body in the hip joint

D) Internal snapping hip syndrome is caused by a tight iliopsoas tendon snapping over the iliopectineal prominence of the pelvis, or less commonly, acetabular labral tear or loose body in the hip joint. A tight iliotibial band or gluteus maximus snapping over the greater trochanter causes external snapping hip syndrome.

Little League elbow: A) Involves the lateral elbow region B) Is an acute dislocation of the elbow C) Occurs most commonly between the ages of 13 and 15 D) Occurs in athletes complaining of medial elbow pain

D) Little League elbow is suspected in a throwing athlete between the ages of 9 and 12 with medial elbow pain and a recent history of throwing. There is tenderness over the medial epicondyle and pain with resisted flexion of the wrist and valgus stress testing of the elbow. There may also be a slight elbow flexion contracture. The pathology is irritation and inflammation of the growth plate on the medial epicondyle.

Which nerve injury results in medial scapular winging? A) Spinal accessory nerve B) Axillary nerve C) Suprascapular nerve D) Long thoracic nerve

D) Long thoracic nerve injury or palsy will result in serratus anterior weakness. The long thoracic nerve originates from the C5-C7 nerve roots, and travels below the brachial plexus and clavicle before ultimately innervating the serratus anterior muscle. The serratus anterior muscle works to protract the scapula and cause its upward rotation, pulling it forward against the rib cage. In medial scapular winging, the scapula comes away from the chest wall medially. Forward flexion of the shoulder is often weaker and limited to 90° relative to the unaffected side. Injury to the spinal accessory nerve results in lateral scapular winging.

The test of choice when looking for labral pathology is: A) MRI B) CT scan C) X-rays D) Magnetic resonance (MR) arthrogram

D) MR arthrogram is the test of choice when evaluating for labral pathology.

Which statement is true regarding medial tibial stress syndrome (MTSS or shin splints)? A) This is a type of overuse injury that results from chronic traction on the periosteum at the periosteal-fascial junction along the anterolateral border of the tibia B) The main predisposing factor is hypersupination C) Patient should continue normal activity D) Pain may improve with exercise but worsens afterward

D) MTSS, also known as shin splints, is a common type of overuse injury that results from chronic traction on the periosteum at the periosteal-fascial junction along the posteromedial border of the tibia. The main predisposing factor is hyperpronation. Pain may improve with exercise but may worsen afterward. Rest is the first priority in management of MTSS. Return to activity should be gradual.

What is Panner's disease? A) Osteochondritis dessicans of the trochlea B) Traumatic elbow dislocation C) Median nerve compression at the elbow by lacertus fibrosis D) Epiphyseal aseptic necrosis of the capitellum

D) Panner's disease is usually seen in young boys aged 5 to 12 years. It is felt to be due to an interruption in the blood supply to the epiphysis resulting in initial resorption followed by eventual remodeling of the epiphysis. This condition most commonly occurs in the dominant arm and is found to be due to chronic repetitive trauma, hereditary factors, and certain endocrine disorders.

When compared to paraplegic patients who were nonathletes, paraplegic patients who participated in sports had: A) More hospital admissions B) More pressure sores C) More susceptibility to infections D) More success in avoiding major medical complications

D) Paraplegic athletes were shown to have fewer hospitalizations, fewer pressure sores, and were less susceptible to infections. There is an increase in athletic opportunities for patients with impairments—there has been a rise in participants in the Paralympic games.

Idiopathic brachial plexitis, usually preceded by a viral illness, is called: A) Thoracic outlet syndrome B) Erb's palsy C) Guillain-Barré syndrome D) Parsonage-Turner syndrome

D) Parsonage-Turner syndrome commonly affects the suprascapular nerve, axillary nerve, and/ or long thoracic nerve, and can be mistakenly attributed to an athletic event because of its idiopathic nature. Its classic presentation is acute onset of pain lasting 1 to 2 weeks and a delayed onset of weakness.

Motions of the hip in Patrick's test are: A) Flexion, adduction, and internal rotation B) Flexion, adduction, external rotation, and extension C) Flexion, abduction, internal rotation, and extension D) Flexion, abduction, external rotation, and extension

D) Patrick's test is a provocative maneuver to assess for sacroiliac joint dysfunction as well as hip joint pathology by flexion, abduction, external rotation, and extension of the hip joint (hence it is also called the FABERE test). FAIR test (flexion, adduction, and internal rotation) is a provocative test for piriformis syndrome.

Which statement is not true regarding plantar fasciitis? A) Increased tension on the plantar fascia leads to chronic inflammation B) Heel spurs may contribute to its etiology C) A tight Achilles tendon is frequently associated with plantar fasciitis D) Night plantar flexion splints are not indicated

D) Plantar fasciitis is caused by inflammation of the plantar fascia. Increased tension on the plantar fascia, such as pes cavus, pes planus, obesity, tight Achilles tendon, or bone spurs can lead to chronic inflammation. Treatment options are mostly conservative, including modalities, nonsteroidal anti-inflammatory drugs (NSAIDs), orthotics or shoe modification (heel pads, cushion, and lift), as well as Achilles tendon and plantar fascia stretching. Anesthetic/corticosteroid injection is effective. Injection from the medial side of the heel helps avoid injection into subcutaneous tissue or fascial layer, which may cause fat pad atrophy/necrosis and fascia rupture. Nighttime dorsiflexion splints may be used if other conservative measures fail.

The Q angle is increased by: A) Genu varum B) Decreased femoral anteversion C) Internal tibial torsion D) Tight lateral retinaculum

D) Q angle is the angle formed by a line drawn from the anterior superior iliac spine (ASIS) to the central patella, and a second line drawn from the central patella to the tibial tubercle. Normally, Q angle is 14° for males and 17° for females. An increased Q angle is a risk factor for patellar subluxation. The Q angle is increased by genu valgum, increased femoral anteversion, external tibial torsion, a laterally positioned tibial tuberosity, or a tight lateral retinaculum.

Scaphoid fractures can be ruled out if the patient: A) Reports falling with an outstretched hand B) Complains of pain over the anatomical snuff box C) Has negative initial x-rays D) Has point tenderness localized to the ulnar aspect of the wrist

D) Scaphoid fractures are the most common carpal bone fractures. They often occur due to a fall on an outstretched hand. Snuff box tenderness may be noted. If initial plain films are negative, then wrist should be immobilized and films repeated in approximately 2 weeks. There is a high incidence of nonunion and avascular necrosis.

Which bone is most commonly affected in a wrist fracture? A) Lunate B) Capitate C) Distal radius D) Scaphoid

D) Scaphoid fractures can be missed but should be suspected in patients with radial wrist pain after trauma. The scaphoid and triquetrum are the most common wrist fractures. Scaphoid and lunate fractures are highly susceptible to avascular necrosis.

Shoulder extension involves the use of all of the following muscles except: A) Pectoralis major, sternocostal portion B) Teres major C) Biceps brachii D) Posterior deltoid

D) Shoulder extension involves the use of the posterior deltoid, latissimus dorsi, teres major, long head of triceps, and sternocostal portion of the pectoralis major.

Which of the following is not true regarding steroid injection for carpal tunnel syndrome (CTS)? A) It is indicated for mild to moderate CTS B) It can be used in conjunction with splinting and physical therapy C) Caution should be used when injecting patients with diabetes D) Is preferable to surgery in patients with severe CTS

D) Steroid injection can be considered in patients diagnosed (by nerve conduction studies [NCV]/ electromyogram [EMG]) with mild to moderate CTS. Care is taken to avoid piercing the median nerve. The needle is directed at an angle of 30°. Surgery is usually required in severe CTS, especially if abnormal spontaneous potentials are noted in the abductor pollicis brevis (APB) muscle.

What is the most common cause of posterior cruciate ligament (PCL) injury? A) Hyperextension of the knee B) Rotation of femur on fixed lower leg C) Hyperflexion of the knee D) Dashboard injury

D) Sudden impact to the front of the tibia with the knee flexed (as in a motor vehicle accident) is the most frequent cause of a PCL injury. Hyperflexion is the most common cause of PCL injuries in athletes.

What describes a swan neck deformity? A) Hyperextended metacarpophalangeal (MCP) and distal interphalangeal (DIP) joints, and flexion deformity at the proximal interphalangeal (PIP) joint B) Synovitis at the ulnar styloid with resultant disruption of the ulnar collateral ligament C) Hyperextension of the MCP and DIP joints with flexion of the PIP joint D) MCP and PIP joint hyperextension with flexion deformity at the DIP joint

D) Swan neck deformity is characteristic of rheumatoid arthritis. The deformity may start at the MCP, PIP, or DIP joint. If the flexor tendon at the MCP joint tightens, this may result in hyperextension at the PIP joint. Alternatively, if the PIP volar capsule becomes lax secondary to tenosynovitis, the PIP joint will hyperextend causing swan necking of the remaining joints. More commonly, however, stretching or disruption of the distal extensor mechanism results in a mallet finger deformity, which leads to eventual PIP hyperextension.

Tennis elbow typically: A) Is an acute lesion, lasting less than a few weeks B) Presents with pain and tenderness over the medial epicondyle C) Does not affect grip strength D) Can occur as a result of a poor tennis backhand stroke

D) Tennis elbow is commonly known as lateral epicondylitis. Patients present with pain and tenderness over the lateral epicondyle as well as over the extensor tendon. There is pain with resistance to wrist and third digit extension. Occasionally, grip strength testing elicits pain. Acutely, there will be inflammatory responses to tension overload placed in the tendon-bone junction. Lateral epicondylitis typically lasts longer than a few weeks. It is caused by a poor backhand stroke in tennis, although this is not always the cause.

In sports, which knee ligament is the most commonly injured? A) Anterior cruciate ligament (ACL) B) Posterior cruciate ligament (PCL) C) Lateral collateral ligament (LCL) D) Medial collateral ligament (MCL)

D) The MCL is the most common knee ligament injury in sports. It is usually caused by a valgus force to the knee joint, causing stretching or tearing of the MCL. Isolated complete tears of the MCL can be treated nonoperatively

All of the following muscles are involved in shoulder adduction, except: A) Pectoralis major B) Teres major C) Coracobrachialis D) Biceps brachii

D) The biceps brachii is not involved in shoulder adduction. In addition to the pectoralis major, teres major, and coracobrachialis, shoulder adduction involves the latissimus dorsi, infraspinatus, anterior and posterior deltoid, and the long head of the triceps.

All of the following are correct regarding the intervertebral disc except: A) The pressure obtained in the sitting position is double the pressure when the patient stands B) The interior of the disc has no nociceptive innervation C) The fibrous outer ring (annulus fibrosis) is held taut by the pressure in the central nucleus pulposus D) The dorsal portion of the annulus fibrosis has no nociceptive innervation

D) The dorsal portion of the annulus fibrosis is innervated by the medial branch of the segmental spinal nerves.

What is plica syndrome of the knee? A) Knee pain caused by a duplicated meniscus B) Knee pain and weakness caused by an inflamed synovial structure in rheumatoid arthritis patients C) Knee pain and weakness caused by a synovial fold in femorotibial joint D) An extension or a vestigial structure of the protective synovial capsule of the knee becomes irritated or inflamed causing anterior knee pain and weakness

D) The knee plica is considered a vestigial structure because of remnant embryological tissue that compartmentalizes the knee during fetal development. This horseshoe-shaped structure can become irritated or inflamed, which causes anterior knee pain and weakness, known as the plica syndrome.

Which of the following statements is not true regarding the meniscus? A) Partial meniscectomy for bucket-handle tearing will still preserve most of the meniscal function as long as the peripheral rim is intact B) The peripheral outer 1/3 of a meniscus is well vascularized, and the inner 2/3 poorly vascularized C) One of the important roles the meniscus plays is in proprioception of the knee D) The tibial-femoral contact area is decreased by up to 25% after total meniscectomy

D) The menisci appear to transmit approximately 50% of the compressive load through range of motion (ROM) of 0° to 90°. The contact area is increased, protecting articular cartilage from high concentrations of stress. The circumferential continuity of the peripheral rim of the meniscus is integral to meniscal function. Partial meniscectomy, or bucket-handle tearing, will still preserve meniscal function as long as the peripheral rim is intact. Conversely, if a radial tear extends to the periphery and interrupts the continuity of the meniscus, the load-transmitting properties of the meniscus are lost. The tibial femoral contact area is decreased by up to 75% in postmeniscectomy knees. This decrease results in a 235% increase in contact stresses after total meniscectomy. The peripheral outer 1/3 of a meniscus is well vascularized, and the inner 2/3 poorly vascularized. Therefore, no surgical repair is needed for the inner 2/3 of a meniscus tear. The meniscus also plays an important role in proprioception of the knee joint.

During which phase of throwing is the elbow joint placed under the most valgus stress? A) Follow-through B) Wind-up C) Early cocking D) Late cocking

D) The phases of throwing in order are: wind up, early cocking, late cocking, acceleration, and follow-through. During late cocking there is significant valgus stress on the elbow joint, with maximal stress on the medial collateral ligament (MCL). The elbow also experiences a significant degree of valgus stress during acceleration, but not as much as late cocking.

What structures are found within the quadrangular space? A) The circumflex scapular artery B) The femoral nerve, artery, and vein C) Processus vaginalis, spermatic cord, and ilioinguinal nerve D) Axillary nerve, posterior circumflex artery, and humeral artery

D) The quadrangular space of the shoulder is bordered by the teres minor, teres major, long head of the triceps muscle, and medial border of the humerus. It is an area of potential compression of the posterior humeral circumflex artery or axillary nerve, especially in athletes who engage in overhead activities (throwing athletes, tennis players, swimmers). Patients will present with pain and paresthesias of the posterior lateral shoulder

Where is the most common site of injury to the spinal accessory nerve? A) At the foramen magnum where it passes before entering the jugular foramen B) At the jugular foramen C) At the cervical root level D) In the posterior cervical triangle

D) The spinal accessory nerve is most commonly injured in the posterior cervical triangle. This will result in isolated trapezius muscle weakness. The mechanism of injury may be stretch or external compression or after surgical procedure (ie, cervical lymph node biopsy). A lesion in this region will spare the sternocleidomastoid of the affected side. Mild scapular winging may also be observed with shoulder abduction (lateral winging).

Identify the final treatment phase of sports rehabilitation: A) Resolving pain and inflammation B) Restoring range of motion (ROM) C) Strengthening D) Sports/task-specific activities

D) There are five treatment phases in sports rehabilitation: the first phase is to resolve the pain and inflammation; the second phase is to restore ROM; the third phase is to strengthen; the fourth phase is proprioceptive training; and the last phase involves sports/task-specific activities.

The differential diagnosis of trigger finger includes all of the following except: A) Dupuytren's disease B) Ganglion of the tendon sheath C) Rheumatoid arthritis D) Phalange fracture

D) Trigger finger is defined as the triggering, snapping, or locking of the finger as it is flexed and extended. This is due to localized inflammation or nodular swelling of the flexor tendon sheath, which inhibits the normal tendon glide. Typically, the thumb, middle, and ring fingers of the dominant hand in middle-aged women are most commonly affected.